دانلود رایگان مقاله زمانبندی تکامل دندان در بیماران استئوژنز ایمپرفکتا

ABSTRACT

Bisphosphonates have established their role as medical therapy for pediatric osteogenesis imperfecta (OI) patients. Since bisphosphonates have also been shown to delay tooth development in animal models, we aimed to assess whether the medication has a similar effect on children with OI. In this cross-sectional study, bisphosphonate-treated OI patients of whom dental panoramic tomograph was taken between 3 and 16 years of age formed the study group. The patients, 22 in total, had been treated with pamidronate, zoledronic acid or risedronate for at least one year before the radiography. Developmental stage of the permanent teeth, resorption of the deciduous teeth, and number of the erupted permanent teeth were radiographically assessed in the left mandibular quadrant. Dental panoramic tomographs of 50 OI patients, naïve to bisphosphonates, and of 50 healthy individuals of the same age were used as controls. The dental development was statistically significantly accelerated in the OI group naïve to bisphosphonates showing median advancement of dental age by 0.63 years from chronological age and median increase in the number of erupted teeth by 0.31 as compared to Finnish norms. Bisphosphonate-treated OI patients displayed, however, age-appropriate dental development. The OI patients not treated with bisphosphonates also showed statistically significantly faster resorption of the deciduous teeth than the treated ones, and displayed an altered interrelationship between the resorption stage of an individual primary tooth and the developmental stage of the succedaneous permanent tooth, unlike the OI patients treated with bisphosphonate. No correlation between either cumulative bisphosphonate dose or between treatment length and any measured component of the dental development was found. To conclude, OI itself was found to lead to advanced dental development. Bisphosphonate treatment had a delaying.

4. Discussion

Our study revealed that OI patients, naïve to bisphosphonates, have on average advanced dental development. As compared to healthy peers they showed acceleration in both dental age and eruption of the permanent teeth. Against this background, we were able to show, in line with our expectations and observations in animal studies, that bisphosphonates slow down dental development in humans as well, and as a new finding, we also demonstrate statistically significant delay in the resorption of primary teeth. Clinically importantly, however, the overall delay due to bisphosphonates is likely to rescue the accelerated dental development in patients with OI to a level comparable to unaffected children. The results confirm our long-term clinical impression that especially in children with more severe types of OI it used to be common in the era before bisphophonate treatment to see relatively early shedding of the primary teeth and replacement by permanent incisors, canines and premolars as well as eruption of the permanent molars particularly in the lower jaw. Children with OI often need extensive and complicated dental care, such as protection of teeth with abnormal dentin with stainless steel crowns or orthodontic treatment. Such treatments are easier to perform in a more mature, co-operative child, and therefore early dental development can be considered a disadvantage.